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Possible Plaquenil side effect?

2488 Views 18 Replies 12 Participants Last post by  Bullwinkle
A very quick question please...

I've just started taking Plaquenil a week ago. Started on 1 for first week. And since yesterday been on 2. Has anyone encountered anything similar to what I've described below?

Since I started a week ago I've noticed a strange heart beat at times - a bit heavy. Even when I'm sleeping on my left side I can feel my heart beat and hear it through my left ear. Also get random pains around the heart area and in the fingers.

Didn't think much of it at first. But then yesterday when I was showering, whilst putting on the shower gel my left hand started to shake. When I stopped applying the shower gel it stopped. And when I started applying again the shaking started again :worried: Eventually it stopped.

BUT then today whilst I was typing a text message on my phone the shaking started briefly, and then went again.

Incredibly worried. Have booked a GP's appointment tomorrow, but wanted to know if anyone has had such an experience :worried:

PS I've not had any noticeable stomach problems on Plaquenil - which I know a lot of people do have.
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Hi Surferboy,

It really doesn't sound like a side effect of plaquenil.

It does sound very much like a symptom of anxiety - where your mental/emotional excitation is being expressed in physical symptoms. What you describe is a classical presentation.

Still, it is always better to be safe than sorry so the GP appointment is a good idea.

If you are having these type of symptoms, it is your body telling you you need to adress your coping strategies and reduce your stress. It is important that you do this, stress is no good for lupus.

Take care

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Hello surferboy

I haven't heard of such an effect with Plaquenil but who knows. Just about anything is possible if an individual is susceptible, but it could be pure coincidence.

Sometimes the only way to know if a medicine is responsible for a new symptom is to stop it and see what happens. If the symptom goes it's reasonable to suppose it was indeed related to the drug and the further proof is the rechallenge by starting the drug again. This should be done under medical supervision but there is no reason why Plaquenil shouldn't be stopped at this stage. Actually it can be suddenly stopped at any stage if medically necessary.

You do well to get it checked out of course but your high levels of anxiety trouble me. There are lots of ups and downs with this illness and especially in the early stages after diagnosis when a person is still getting familiar with lupus, especially with their sort of lupus, and investigations are ongoing. I am not suggesting that your current symptoms are due to anxiety nor am I trivialising your concerns, because I am a very anxious person myself and was at one stage of my life literally crippled with it. So I know how terrible it can be and take expressions such as "incredibly anxious" very seriously despite not knowing exactly how this degree of anxiety is affecting you physically.

I do know how horrible anxiety is as a mental state and I am sure it does no good at all to the immune system. All that "fight or fight" adrenalin rushing around. A lot can be learnt about reducing anxiety and learn how to deal with it sensibly. I know other people have commented on this but I haven't noticed you responding to their suggestions.

Undue levels of anxiety are physically harmful in my opinion. Exercise is beneficial of course but finding that "still small voice of calm " is also tremendously therapeutic.

By the way, I think you are only taking ibuprofen now and then as needed and I hope not exceeding the recommended dosages. Even over the counter meds need to be taken respecting the dosages. "Swallowing a few" or however you put it, sounds a bit casual although maybe it was simply a way of talking.
By the way Ibu is not the first choice of NSAID for lupus. What happened to the consultant's recommendation of Diclofenac ?

Let us know what your doctor says. Plaquenil is so hugely beneficial you don't want to stop taking it unless there is a very good proven medical reason.
Also by the way, have you heard of the 'nocebo' affect? It is the opposite of the placebo effect and means if you think or fear a drug will do you harm, it is more likely not to be effective and have unpleasant side effects. The mind can be scaringly powerful.

I hope you now have a rheumatologist you trust and feel confident in.

All the best
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Hi Surferboy,

The following link has the normal side effects for Plaquenil. Hope this will help you.

Take care,
hi surferboy

I cannot tell you anything about plaquenil as i have just started to take mine today.
However last week i had shaking hands a few times it did go away,i was not concerned but it was ver annoying when trying to hold a cup of tea etc.i have not posted before to you but i have been very interested in your questions as i was waiting to see the rhuemy today and you have helped me by asking the questions which i am no good at, this i thank you for.
The only thing i have noticed is the horrible taste in my mouth from them.

Huggs Sandy
Hi Surferboy,
I was just started on Plaquenil too, so I can't really speak to that.

But I do have a lot of experience with anxiety. First, I think its important to take chest pain and strange heart beats seriously and get checked out.

With that said, my anxiety mimicked heart disease many times, and I found myself in the MD office of ER many times thinking I was having a heart attack. My anxiety presents with shortness of breath, chest pain, palpitations, fear, numbness, tingling of lips and face, wobbly legs, needing fresh air, fear, paranoia, stomach ache, red face, shaking legs and hands... Oh, I could go on and on...

I had to learn to decipher anxiety from physical ailments. Mainly I had to learn to calm myself down with breathing and other 'grounding' exercises. I can provide more info if you want. I use these techniques a lot and I'm able to calm myself down and decipher whether my symptoms merit a call to the MD or not.
My other advice would be if they do diagnosis you with anxiety, think long and hard about starting on a benzodiazipine (Ativan, Klonopin, Valium etc) as they are VERY addictive even with small doses and short term use. I've been through the withdrawal and it is absolutely horrible.
I wish you luck in figuring this out, I think its smart to have the chest and heart rate symptoms checked out. Hope it goes well.........
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Thanks All for your replies.

I've started to take deep breath's to calm myself down a touch :)

One more quick question though... what should I do if I take 3 plaquenils (by mistake) in 1 day rather than 2? Should I rush my self to emergency? Or just skip a dose the following day?
I would phone the GP Oncall helpline for advice!

I'm sure you'll be fine and wont need to rush to A&E!

Let us know what they say!

Hi Surferboy,

In the future to avoid an under or over dosage of your medication you should consider using some type of pill case. With our minds always in a number of different places it is very easy to make a mistake.

Take care,
Hi Surfer,

Your symptoms that your describing are something I experience almost daily...the rapid irregular heartbeat, tremors, etc...I think you will be ok and I do not think it is a side effect from Plaquenil.

As far as 3 pills in one day................:eek::eek::eek:

I think you should call the doctor but I am sure you will be ok.:wink2:
Hi There,
I am diagnosed with MCTD i also take plaq. i don't think what you are reffering too is a side effect of plaq but i would menntion this to your doc just incase it could be a less common one.

I reallt empathise with the chest pain you have described i have chest pains every day around my heart area and all over my chest. Chest pain can be quite worrying an cause a lot of anxiety.
Palpitations can be caused by anxiety. I have had palpitations a couple of times in the past and was told by my doc that people with perfectly normal heart function can experience them for lots of different reasons without concern. She also said that they would not really look on it with concern unless it was lasting for 10 minutes or more.
I did have and echocardiogram after this about 7 yrs ago which i had perfectly normal heart function for someone my age despite having a murmur.
I would definately talk all this through your doc to illimainate and possible cause for worry or concern or anxiety.
Just another thought but i have read from patient experinces that plaq can initially lower the blood sugar levels which would definately explain the shakiness and increased heart rate.

Hope this helps a bit.

Take Care

Good Luck

Cassie :)
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The forum can't ever assure people that they do not need to get medical assistance. The general rule has to be to get help if you are worried, better safe than sorry. Knowing when to seek medical help is part of living with lupus, in fact part of well living, although if you have been generally healthy there is more to learn about this sort of decision making. The decision to get help also depends on experience and knowledge, how much you know about whatever the health problem is. We all need general knowledge about what could be an emergency - such as signs of heart attack, in women and men.
Chest pains should never be neglected and it shouldn't be assumed that they are due simply to a new med - even if they are it might not be harmless.

The relevant knowledge here, at least for me, is that a few people take 600mgs a day Plaquenil especially at the start of treatment. The 400mgs a day is the maximum recommended dose to avoid risk of side effects. Nowhere does it say that 400 mgs should not be exceeded in any circumstances. So the likelihood of seriously overdosing by taking 600 mgs a day is slim. It might cause tummy upset or other passing symptoms, I suppose.
There should be a manufacturer's leaflet or copy of when you get the pills.

From googling ( Plaquenil overdose) it seems that the effects of a true Plaquenil overdose come on rapidly, within 30 minutes. They are described as headache, visual disturbance, cardiovascular collapse and convulsions, followed by sudden and early respiratory and cardiac arrest. The case accounts I read were very clear instances of deliberate overdosing.

A weekly pill box is an excellent idea but also have a think about why this happened. Most people have the opposite problem! If you ever don't know whether you took one or not, best to write that dose off. When we start taking meds we have to focus on making it part of a regular routine, deciding the best place to keep the pills for example.

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Thanks all for the replies.

I visited my GP yesterday who did a rough/quick/half hearted "check over" and said he couldn't find anything wrong.

He also said not to worry about my stupidity in taking 1 too many plaquenil!

But I like the idea of the pill box.

I think the only reason I took 2 in one go was due to the habit of taking 2 paracetemol.

Clare, i'm currently not on any painkillers as thankfully no joint pains recently. Fingers crossed.
Well, my random chest pains and rapid heart beats haven't stopped much and so have decided to stop plaquenil till I speak to my Rhumy (going to try and contact her secretary next week). In fact, I now have a dull pain on the left side of my chest most of the time :(

I was at a friends house last night and saw his parents blood pressure tester and so tested myself. My Pulse rate was 88 - at rest. Pretty High!! I've also had "quivering/slightly trembling" legs and hands.

The legs and hands may be down to anxiety, but not to sure now about anxiety in relation to the chest pain :(

Have you condidered the possibility that its the Lupus symptoms that are aggrevated in their own right at the moment!

I cant tell you to stop or continue with Plaquenil, but I do think you should seek medical advice from a specialist etc before you stop.

If your chest pains are that worrying then go to A&E or at least phone the GP Oncall for advice! Chest pains should never be ignored or self-diagnosed -seek proffessional care at all times!

Re. the pulse rate - I'm not sure that 88 is that high at resting! If your stressed and anxious then it came be higher just like the systollic and dystollic readings of BP!

Take care anyway!

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You really need to talk to your doctor before deciding to change/stop any of your medications. It is pretty well documented that a lot of Lupus patients will go into a flare when they stop Plaquenil. I hope you have a doctor you trust for advice on this. You really shouldn't be making this decision without talking to your doctor.

Hope you get this figured out soon!

Take care,
Hi again surferboy,
I think Lesley is absolutely right and playing about with medication without the advice of your doc could potentially make you must worse.
Chest pain is extremely common in MCTD and Lesley is right that it coould be related to the diseaseand not the medication. As i explained before i suffer constant chest pain which is related to the disease.
It is good that you have seen your doc and he has eliminated an infection and has checked your heart.
I also don't think that an 88 pulse is that high really especially if you felt anxious at the time.
I do think it would be worth checking with your doc about possible low blood sugar called hypoglycemia aswell as increased heart beat, and shaking are classic symtoms of this, aswell as sweating .
I have attached an article which refers to this happening in a sudy of the drug.

I hope this helps and is definately worth checking this with your doc.
I am sure as you are not already diabetic that this can be easily rectified, perhaps by having a sweet drink and few biccies when taking it and ensuring that you try to eat regularly.

I hope this helps

Good Luck

Cassie :)

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Plaquenil & Anxiety, Tremors

In reply to SurferBoy -

I have been on Plaquenil for about 7 years. Shortly after I started taking it I noticed the hand tremors. When I started on it the pharmacist could not find any reference to any psych or tremor effects, so I stayed on it.

The tremors come and go, sometimes they can be really annoying, but I do think they are due to the anxiety that the Plaquenil causes, not a side effect themselves. I have had scans & all sorts of nerve conduction studies, but the neurologist(s) cannot find a thing!

I do think it is due to the P, but it manages my lupus so well I am afraid to go off of it. My sed rate was around 65 when I went on it, now stays under 10 regularly. I haven't had any flares in years.

I have noticed that I am a lot more anxious & suffer from depression at times too. My memory is SHOT, but not sure if that is due to ignoring my lupus symptoms in college & partying, killing too many brain cells. DUMB! Anyway, all meds have some side effects... hopefully the good outweighs the bad.

I may consider going off of P if I can find something to help keep my inflammation in check - I do sometimes feel a bit loony - maybe it would help to change!?
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You need to check with your Dr. before stopping any medication. Please heed the "street" advice of those who have answered you before me , as you are discounting the symptoms of your affliction , and attributing them to the medications which to me is a false assumption.
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